基于筋骨评估模式指导手法治疗腰椎间盘突出症  

Manipulation treatment of lumbar disc herniation based on the model of muscles and bones assessment

作　　者：薛彬[1,2] 刘涛 朱宏[1] 李飞跃[1] 张佳玉[1] 王强 奚小冰 孔令军[3] 周鑫[4] 朱清广 房敏[3] XUE Bin;LIU Tao;ZHU Hong;LI Fei-yue;ZHANG Jia-yu;WANG Qiang;XI Xiao-bing;KONG Ling-jun;ZHOU Xin;ZHU Qing-guang;FANG Min(The Ruijin Hospital Afiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;School of Acupuncture-Moxibustion and Tuina,Shanghai University of Traditional Chinese Medicine,Shanghai201203,China;Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai201203,China;Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai200437,China)

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025 [2]上海中医药大学针灸推拿学院,上海201203 [3]上海中医药大学附属曙光医院,上海201203 [4]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《中国骨伤》2024年第11期1080-1086,共7页China Journal of Orthopaedics and Traumatology

基　　金：国家中医药管理局中医药创新团队及人才支持计划项目(编号:ZYYCXTD-C-202008);上海市“科技创新行动计划”医学创新研究专项重点项目(编号:21Y21920300);上海市卫生健康委员会中医药科研专项(编号:2022QN026);上海市2023年度“科技创新行动计划”自然基金面上项目(编号:23ZR1440400)。

摘　　要：目的:探讨基于“筋骨评估”模式指导的手法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法:自2022年5月至2023年8月采用单中心随机对照研究方法,在上海交通大学医学院附属瑞金医院收治72例LDH患者,分为筋骨评估模式手法组和二步七法手法组,其中筋骨评估模式手法组脱落1例,二步七法手法组脱落2例。筋骨评估模式手法组35例,男12例,女23例;年龄27~48(37.77±7.63)岁;病程35~180(83.68±69.01)d;L4,522例,L5S113例;予筋骨评估模式指导下的手法治疗,每周3次,治疗4周。二步七法手法组34例,男12例,女22例;年龄26~49(37.59±7.43)岁;病程40~175(82.15±68.87)d;L4,523例,L5S111例;予二步七法手法治疗,每周3次,治疗4周。分别于治疗前和治疗4周比较两组疼痛视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)评分、肌张力、腰椎活动及直腿抬高角度,以及影像学姿势体位评估结果比较。结果:筋骨评估模式手法组和二步七法手法组VAS分别由治疗前的(6.51±0.61)、(6.62±0.56)分,降至治疗后4周的(2.40±0.81)、(3.18±0.78)分,且治疗4周后筋骨评估模式手法组较二步七法手法组降低(P<0.01)。筋骨评估模式手法组和二步七法手法组ODI分别由治疗前的(64.57±5.11)%、(65.02±5.18)%,降至治疗4周后的(18.60±2.27)%、(24.70±2.14)%,筋骨评估模式手法组ODI较二步七法手法组降低(P<0.01)。治疗前,筋骨评估模式手法组竖脊肌、臀中肌、腓肠肌肌张力分别为(59.95±2.60)、(62.59±2.51)、(49.97±2.01),二步七法手法组分别为(60.39±3.84)、(62.47±3.27)、(49.55±1.27);治疗4周后,筋骨评估模式手法组患侧竖脊肌、臀中肌、腓肠肌肌张力分别为(56.58±2.71)、(60.44±2.31)、(48.19±1.57),二步七法手法组分别为(58.28±3.79)、(60.11±2.87)、(48.55±0.90),两组组内治疗前后比较,差异有统计学意义(P<0.01);组间比较,筋骨评估模式手Objective To explore the effectiveness of manipulation treatment for lumbar disc herniation(LDH)based on the model of muscle and bone assessment.Methods From May 2022 to August 2023,using the methods single-center randomized controlled in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,72 patients were treated with LDH and divided into muscle and bone assessment model manipulation group and the two step seven gimmick group according to the random number table method,the muscle and bone assessment model manipulation group fall off in 1 case,the two step seven gimmick group falls off in 2 cases.There were 35 cases in the muscle and bone assessment model manipulation group,including 12 males and 23 females;The age was 27 to 48 years old with an average of(37.77±7.63)years old.The course of disease was 35 to 180 days with an average of(83.68±69.01)days.The patients were treated with manual therapy under the guidance of muscle and bone assessment model,twice a week for 4 weeks.There were 34 cases in the two step seven gimmick group including 12 males and 22 females;The age was 26 to 49 years old with an average of(37.59±7.43)years old;The course of disease was 40 to 175 days with an average of(82.15±68.87)days.The patients were treated with two step seven gimmick method,2 times a week,for 4 weeks.The visual analogue scale(VAS)and Oswestry disability index(Oswestry disability index,ODI)questionnaire,muscle tension and lumbar spine angle and the straight leg-raising activities were compared between two groups before and 4 weeks after treatment.Results The VAS of the muscle and bone assessment model manipulation group and the two step seven gimmick group(6.51±0.61)and(6.62±0.56)before treatment decreased to 2.40±0.81 and 3.18±0.78 after 4 weeks of treatment,respectively,and the muscle and bone assessment model manipulation group was significantly lower than the two step seven gimmick group(P<0.01).The ODI of the muscle and bone assessment model manipulation group and the two step sev

关 键 词：筋骨评估 腰椎间盘突出症 手法 评价 

分 类 号：R274.31[医药卫生—中医骨伤科学]